=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851248504
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JACKSON RECOVERY CENTERS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2026
-----------------------------------------------------
Last Update Date | 03/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 RUSSELL ST STE A
-----------------------------------------------------
City | CRESTON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50801-3149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-391-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 5TH ST STE 200
-----------------------------------------------------
City | SIOUX CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51101-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIR REVENUE CYCLE
-----------------------------------------------------
Name | BRITTON CARLSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 815-387-5664
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------